Effective January 1, healthcare insurer UnitedHealthcare said it will conduct "site of care" reviews during the prior authorization process for certain hospital outpatient MRI and CT studies as part of the payor's initiative to shift imaging from hospitals to freestanding imaging facilities.
Announced in UnitedHealthcare's October bulletin, the policy is intended to minimize out-of-pocket costs for UnitedHealthcare members and to improve cost efficiencies for the overall healthcare system, according to the company. Site reviews will not be performed if the imaging procedure is to be provided at a freestanding diagnostic imaging center or in an office setting, according to the insurer.
The policy change applies to all states except Iowa, Kentucky, and Utah, and it will be implemented on UnitedHealthcare commercial benefit plans, including exchange benefit plans and its Neighborhood Health Partnership, UnitedHealthcare of the River Valley, and UnitedHealthcare benefit plans.
UnitedHealthcare noted that the notification/prior authorization process is not required for any advanced outpatient imaging procedure rendered during an inpatient stay or in an emergency room, urgent care center, or observation unit.
